Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan.
J Artif Organs. 2024 Sep;27(3):238-246. doi: 10.1007/s10047-023-01406-y. Epub 2023 May 25.
A narrow terminal aorta is a risk factor for endograft occlusion after endovascular aneurysm repair. To minimize limb complications, we used Gore Excluder legs positioned side-by-side at the terminal aorta. We investigated the outcomes of our strategy for endovascular aneurysm repair in patients with a narrow terminal aorta.
We enrolled 61 patients who underwent endovascular aneurysm repair with a narrow terminal aorta (defined as < 18 mm in diameter) from April 2013 to October 2021. The standard procedure involves complete treatment with the Gore Excluder device. When other types of main body endografts were used, they were deployed proximal to the terminal aorta, and we used the Gore Excluder leg device in the bilateral limbs. Postoperatively, the intraluminal diameter of the legs at the terminal aorta was measured to assess the configuration.
During the follow-up period (mean: 2.7 ± 2.0 years), there were no aorta-related deaths, endograft occlusions, or leg-related re-interventions. There were no significant differences between the pre- and postoperative ankle-brachial pressure index values in the dominant and non-dominant legs (p = 0.44 and p = 0.17, respectively). Postoperatively, the mean difference rate (defined as [dominant leg diameter-non-dominant leg diameter]/terminal aorta diameter) was 7.5 ± 7.1%. The difference rate was not significantly correlated with the terminal aortic diameter, calcification thickness, or circumferential calcification (r = 0.16, p = 0.22; r = 0.07, p = 0.59; and r = - 0.07, p = 0.61, respectively).
Side-by-side deployment of Gore Excluder legs produces acceptable outcomes for endovascular aneurysm repair with a narrow terminal aorta. The endograft expansion at the terminal aorta is tolerable without influencing calcification distribution.
在血管内动脉瘤修复后，主动脉终末狭窄是内漏的一个危险因素。为了最大限度地减少肢体并发症，我们在主动脉终末处并排使用戈尔 Excluder 分支。我们研究了在主动脉终末狭窄患者中使用这种血管内动脉瘤修复策略的结果。
我们招募了 61 名 2013 年 4 月至 2021 年 10 月期间因主动脉终末狭窄（定义为直径<18mm）行血管内动脉瘤修复的患者。标准手术方法是完全使用戈尔 Excluder 装置进行治疗。当使用其他类型的主体内支架时，它们被放置在主动脉终末的近端，我们在双侧肢体中使用戈尔 Excluder 分支装置。术后测量主动脉终末处分支的管腔直径，以评估形态。
在随访期间（平均：2.7±2.0 年），没有与主动脉相关的死亡、内漏或分支相关的再干预。在优势和非优势腿的踝肱指数术前和术后值之间没有显著差异（p=0.44 和 p=0.17）。术后，平均差异率（定义为[优势腿直径-非优势腿直径]/主动脉终末直径）为 7.5±7.1%。差异率与主动脉终末直径、钙化厚度或周向钙化无显著相关性（r=0.16，p=0.22；r=0.07，p=0.59；r=-0.07，p=0.61）。
并排放置戈尔 Excluder 分支可获得可接受的血管内动脉瘤修复结果，用于治疗主动脉终末狭窄。主动脉终末处的内漏扩张是可以耐受的，不会影响钙化分布。
